Glimmers of Hope for Patients with Substance Use Disorder

There is arguably no area of healthcare in the U.S. that has had a greater human and economic cost while being less effectively addressed than Substance Use Disorder (SUD). SUD is generally defined as a treatable mental disorder that affects a person's brain and behavior, leading to their inability to control their use of legal or illegal drugs, alcohol, and other substances. Symptoms can be moderate to severe, with addiction being the most severe form of SUD. These are some of the sobering statistics on the human cost of SUD…

• 46.8 million Americans had SUD in 2023, approximately 14 percent of everyone 12 years and older.?
• 90 percent of those with SUD didn’t receive any care, and only 2 percent received evidence-based care.
• 56 percent were unhoused, 47 percent were BIPOC (Black, Indigenous, and People Of Color), and 99 percent had comorbid mental conditions.
• Nearly half of young American adults 18-25 had either a SUD or a mental illness.
• Millions of children live with parents who misuse substances or have SUD.
• 117,000 died of drug overdoses in 2023, and approximately 178,000 from excessive alcohol use.

?And here are some estimates of the financial cost…

• $47.3 billion was spent on SUD in 2023 by Medicaid and employer-sponsored plans.
• $15,640 is attributable per SUD patient cost to payers annually.
• The total annual cost of substance abuse in the U.S. has been conservatively estimated to be more than $600 billion.

Increasingly Complex Treatment Challenges

As described to me by Jordan Hansen, the co-founder and CEO of an innovative new company called YourPath, which is dedicated to creating a systemic solution to the massive SUD problem, its drug-related challenges have grown and evolved significantly over the past decade. COVID shattered already fragile connections between patients and treatment / recovery resources, then the Opioid Crisis snowballed, and more recently, Fentanyl, Methamphetamine, and other even more dangerous, illegal drugs became commonplace.?

To give you an idea of how dangerous synthetic opioids are, Fentanyl is about 50 times stronger than heroin and 100 times more powerful than morphine, and there is a recent variant called Carfentanil that is 100 times more potent than Fentanyl and 10,000 times more potent than morphine.?

A single Fentanyl pill can be deadly, but even if it is not, medical treatment related to Fentanyl and drugs that are laced with it and other illicit substances is far more challenging than treatment of other substance use issues. Naloxone, which has proven effective in treating opioid overdoses, is much less effective when the newer illicit drugs include Fentanyl or other adulterants, which they frequently do. In addition, a recent surge in the use of methamphetamine is particularly problematic, because – as compared to the more sedating effects of opioids – meth can produce aggressive behaviors that can be destructive to others.

Further complicating the new treatment challenge is the fact than many SUD patients are difficult to engage with on an ongoing basis for some of the reasons mentioned in the human cost section above, including the fact that many are homeless and lack regular modes of communication or transportation. Additionally, evidence-based practices such as the use of medications for opioid use disorder (MOUD) still aren’t embraced by most specialty treatment providers. The tragic result, according to Hansen, is that many SUD patients get better care in correctional institutions than they do outside of them. ?

With that said, SUD patients are not particularly hard to find. It is estimated that 60 percent of Emergency Department patients are there because they have one or more SUDs or because of an injury related to or caused by substance use, while many other SUD patients can be found in county jails. The problem is that, because care teams in these settings are generally not trained to treat the underlying causes of SUD-related visits, they end up treating the symptoms rather than the disease and simply “boarding” SUD patients (mostly at significant taxpayer expense) until they are well enough to be released – in many cases only to return in the same or worse conditions in the future.

Emerging Solutions

Hansen and his team have created a “software and care” solution that has shown significant promise in Minnesota markets and is now being introduced in Kentucky (in the geographic center of the Opioid Crisis). The company’s proprietary software platform enables users to quickly assess potential SUD patients and connect them virtually to local networks of company-employed or vetted third-party psychiatric, housing, food, transportation, and vocational resources, and the platform enables patients to securely communicate with these resources. ?

The software platform is in many cases used by YourPath’s trained “Peer Recovery Specialists” who are embedded in ED care teams and other settings that tend to attract large numbers of substance impaired individuals to take the SUD hand-offs after the primary reasons for the visits have been addressed. In other cases, the company provides implementation support to their health system or state agency clients / licensees, including the identification and training of recovery and support specialists and partners.?

YourPath’s programs are showing ROIs as high as 11:1 from improved access to evidence-based care (including medications for opioid and other substance use disorders, psychiatry, and psychosocial supports), reduced boarding in ED and inpatient medical/surgical settings, and improved connectivity to longitudinal services. Patients in the company’s ED program are 29 times more likely to engage in treatment, their open rates for text messages sent through the platform average 87 percent, and 91 average Net Promoter Scores indicate high levels of patient satisfaction. ??

It is way too soon to declare victory over the enormous and seemingly intractable SUD problem (including the massive supply side issues), but these and other early results from YourPath’s programs are encouraging. Laura Schrag, MD, Medical Director of Emergency Medicine at HennepinHealthcare in Minneapolis puts it this way: “YourPath is helping us address one of the most dangerous and stubborn gaps in Emergency Department services for people with issues related to substance use. This program has the potential to be a national model for health systems around the country.”

After many years in which it has seemed as if the SUD challenge was only growing in magnitude and complexity, the efforts of YourPath and other innovative, SUD-focused companies are finally providing hope for the millions of SUD patients and their families and communities. In addition, there is some early evidence that GLP-1 drugs that have proven effective in diabetes control and weight loss may one day help to treat SUDs. More to come on this and other promising advances in SUD treatment, but the research is ongoing and the tide may finally be starting to turn.

Respectfully yours,

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